Solitary vertebral metastasis of primary clear cell carcinoma of the liver: a case report and review of literature

Abstract

Primary clear cell carcinoma of liver (PCCCL) is an uncommon variant of primary hepatocellular carcinoma.Though the literature describes a better prognosis in relation to the proportion of clear cells in the tumour when compared to the other variants, there is no general consensus in the management due to its rarity and unclear clinicopathological and prognostic factors. There is dearth of evidence with regard to the metastasizing nature of PCCCL and its management. In addition, the management of recurrent spinal tumours both primary and metastatic is not clear as the available evidence is mostly based on case reports.We describe an unusual presentation of PCCCL with solitary spinal metastasis and further complicated by tumour recurrence in a 71-year-old male. Such presentation has never been described before. He presented with low back pain and incomplete neurological deficits involving both lower limbs. On detailed evaluation, he was found to have a solitary metastasis at L3 vertebra secondary to PCCCL. He underwent radical excision of tumour and reconstruction for the solitary metastasis at L3 vertebral body and trans arterial chemo embolisation (TACE) for the hepatic lesion. Pt was asymptomatic until 9 months post operatively when he developed tumour recurrence at L3 vertebra. Patient subsequently underwent 2 stage palliative surgery followed by radiotherapy and chemotherapy. At his latest follow-up (1 year), the patient's overall general condition has improved with residual neurological deficits in the lower limb. PCCCL is a rare type of hepatocellular carcinoma which can present as "solitary metastasis" to the spine. Although the literature suggests a good prognosis for this histological type, this case did not have a good outcome. In addition to providing information for the management of similar cases in the future, this case report highlights that every patient has to be managed on a case-by-case basis.

Development and Identification of a Nomogram Prognostic Model for Patients with Primary Clear Cell Carcinoma of the Liver

“…Additionally, a report considered that postoperative adjuvant chemotherapy with calcium folinate and tegafur resulted in no significant improvement in the survival time of PCCCL patients [5]. Similarly, 3 other case reports regarding unresectable PCCCL patients also approved the opinion that PCCCL was not susceptive to chemotherapy and radiotherapy, exhibiting undesirable survival time [12,16,29]. Intriguingly, in 2019, a case report firstly discovered that sunitinib-based systematic therapy clinically cured a male PCCCL patient with multiple metastatic lesions [30].…”

Breast Metastasis in a Patient with Primary Hepatocellular Carcinoma

“…The incidence of hepatocellular carcinoma varies among geographical areas, with greater incidence being found in Asia, Taiwan, Korea, China and Japan [1][2][3][4][5][6][7]. Advanced hepatocellular carcinoma is one of the most lethal diseases and includes metastases to various organs, such as lungs, lymph nodes, musculoskeletal structures, peritoneal surface, gastrointestinal tract, spleen and pancreas [7][8][9][10]. It has only few systematic therapeutic options, with Sorafenib, being the most important pos administered molecular drug, that increases overall survival by approximately 3 months (10.7 months) compared with placebo (7.7 months) [6].…”

“…Hepatocellular carcinoma (HCC), is the 4 th most common neoplasm in men and 9th most common neoplasm in women, making it one of the leading causes of cancer-related deaths (approximately 600.000 deaths/year worldwide) [1][2][3][4][5][6][7][8][9][10][11][12]. Its geographical distribution varies according to the prevalence of known aetiologic factors such as HBV, HCV infection, alcohol, cirrhosis [12].…”

“…Bachtiar et al, reported right mandible and coracoid process metastases, in a patient with newly diagnosed hepatocellular carcinoma, that had right lower tooth pain and swelling over the right mandible, as well as right shoulder pain, with no associated trauma[7]. Maharajan et al, reported a L3 vertebra solitary metastasis, from primary clear cell carcinoma of the liver, presenting as low back pain and Adnot et al, published a case report, describing a maxillary metastasis, presenting as a hemorrhagic mass of the oral cavity[8,9].Al-Sharidah et al, reported a case of a 31 years old female patient, with chronic HBV infection, that presented to the outpatient clinic with 6 months mastalgia, and a palpable mass on the left breast. In contrast to our case, though, it was revealed through CT scan of the thorax, that the mass had origin on the 3rd rib of the left thorax and was bordering the ipsilateral major pectoralis muscle, invading the muscle and the soft tissue of the breast.…”

Effect of infection after liver cancer interventional therapy on T lymphocyte subsets and Toll-like receptors in peripheral blood mononuclear cells and its mechanism

“…Liver cancer is a common malignant tumor characterized by high morbidity and mortality. [1][2][3] For patients with early liver cancer, surgery is the most effective treatment. However, in most cases, the tumor has progressed to the middle or advanced stage at diagnosis, and patients have missed the best opportunity for surgery due to the insidious onset of symptoms.…”